tbuckley/cabot-search huggingface dataset:
Abstract 11457: Long Noncoding RNA LncAPAT Promotes Atherosclerotic Plaque Instability by Targeting Ribosomal Protein L22
Authors: Adalaiti Kamili, Rongxia Li, Shujun Yang, Weili Zhang
Journal: Circulation (2022)

Introduction: Atherosclerosis is a chronic inflammatory disorder and macrophages play a critical role in the progression of atherosclerosis. Long noncoding RNAs (lncRNAs) participate in the process of macrophage inflammation and atherosclerosis. But the molecular mechanisms underlying the function of lncRNAs in macrophages during the development of atherosclerosis are largely unknown. Hypothesis: We hypothesized that lncRNAs may regulate inflammatory response of macrophages and atherosclerotic plaque instability. Methods and Results: Subjects with suspected coronary artery disease were examined by coronary computed tomography angiography and divided into control (without &gt;1 mm 2 lesions) and mixed plaque groups (with plaques containing lipid, fibrous and calcified components). With whole transcriptome sequencing and further confirmation of real-time PCR in peripheral bloods, a novel lncRNA (named hereafter, atherosclerotic plaque instability associated transcript, lncAPAT ), was identified to express at high levels in patients with mixed plaques. A murine model with monocyte-specific knock in of lncAPAT was generated. ( LncAPAT significantly promoted plaque burden by 1.67-fold in the aorta of MØ lncAPAT mice compared with control group (MØ control mice). Immunofluorescence analysis showed an elevated numbers of macrophage (by 88%) and increased expression of matrix metalloproteinase (MMP) (MMP9 by 7.7-fold and MMP2 by 86%) in plaques of MØ lncAPAT mice. LncAPAT significantly promoted monocytes adhesion to endothelium in vitro and increased the expression of tumor necrosis factor α and intercellular adhesion molecule 1. LncAPAT also enhanced the lipid uptake ability of macrophages. Chromatin isolation by RNA purification-sequencing assay showed that lncAPAT interacted directly with the promoter region of the ribosomal protein L22 gene (RPL22), and it promoted inflammatory response of macrophages by inhibiting the transcriptional activity of RPL22. Conclusion(s): Our findings first identified that lncAPAT was upregulated in patients with coronary vulnerable plaques and promoted the inflammatory response of macrophages by inhibiting the transcriptional activity of RPL22, thereby contributing to plaque instability.
Abstract 11212: Mirabegron Relaxes Arteries From Human Visceral Adipose Tissue Through Antagonism of Alpha <sub>1</sub> -Adrenoceptors
Authors: Francesca SCHINZARI, Alessandro De Stefano, Giuseppina Vizioli, Manfredi Tesauro, Carmine Cardillo
Journal: Circulation (2022)

Introduction: As adequate perfusion has turned out to be a key determinant of adipose tissue (AT) remodeling, interest has grown regarding possible pharmacological interventions to promote this process and hence prevent the metabolic abnormalities associated with obesity and aging. Clinical trials have shown that mirabegron improves insulin sensitivity and glucose homeostasis in obese humans via stimulation of β 3 -adrenoceptors. Ligands of these receptors have also emerged as endothelium-dependent vasodilators in disparate human vascular beds. Hypothesis: We hypothesized, therefore, that mirabegron might exert vasodilator effect in human AT arteries and tried to characterize the underlying mechanism(s). Methods: Small arteries (116-734 μm) isolated from visceral AT were studied ex vivo in a wire myograph. After vessels had been contracted, changes in vascular tone in response to mirabegron were determined under different experimental conditions. Results: Mirabegron elicited vasorelaxation in vessels contracted with endothelin-1 (P&lt;0001), but not in those contracted with U46619 or high-K + (both P&gt;0.05). Notably, mirabegron markedly blunted the contractile effect of the α 1 -adrenergic receptor agonist phenylephrine (P&lt;0.001). Also, vessels with removed endothelium contracted with phenylephrine had preserved vasorelaxing response to mirabegron. The anti-contractile action of mirabegron on phenylephrine-induced vasoconstriction was not influenced by the presence of the selective β 3 -adrenoceptor blocker L-748,337 (P&lt;0.05); lack of involvement of β 3 -adrenoceptors was further supported by absent vascular staining for them at immunohistochemistry. Similar to the observed effect of mirabegron, preincubation with the α 1 -adrenoceptor antagonist doxazosin abolished the contractile response to phenylephrine. Conclusions: Mirabegron induces endothelium-independent vasorelaxation in arteries from visceral adipose tissue, likely through antagonism of α 1 -adrenoceptors. This action suggests that mirabegron might effectively improve visceral AT perfusion, thereby favoring a healthy AT remodeling and preventing, in turn, some of the unwanted cardiometabolic consequences of obesity and aging.
Abstract 11549: Neighborhood Racial Segregation and Access to Transcatheter Aortic Valve Implantation Among Medicare Fee-for-Service Beneficiaries
Authors: Jonathan Sevilla-Cazes, Zaid Almarzooq, Ashley Kyalwazi, Yun Wang, Jordan B Strom, Rishi Wadhera, Robert W Yeh
Journal: Circulation (2022)

Introduction: Lower rates of transcatheter aortic valve implantation (TAVI) among Black individuals have been observed, the drivers of this disparity remain poorly understood. We studied the association between county-level racial segregation and rates of aortic stenosis (AS) diagnosis and management. Methods: We identified Black and white Medicare fee-for-service beneficiaries living in metropolitan areas between 2016 and 2019. Using the American Community Survey’s residential segregation index (SI), a measure of geographic distribution of Black and white residents ranging from 0 (complete integration) to 100 (complete segregation), we determined segregation in each beneficiaries’ county of residence. We calculated population-level rates of AS diagnosis and TAVI using validated ICD-10 codes. Using hierarchical modeling, we determined the association between racial segregation and rates of AS diagnosis, TAVI receipt, and 30-day mortality. Results: A total of 29,264,075 beneficiaries were included in the analysis. Living in a high-segregation county (SI&gt;60) was associated with increased rates of AS diagnosis overall (adjusted OR 1.03 95%CI 1.02-1.03) but no difference in TAVI. However, among Black beneficiaries, increasing county-level segregation was associated with decreased rates of AS diagnosis and TAVI; the opposite association was observed among white beneficiaries ( Figure 1 ). Among those with an AS diagnosis, the interaction between Black race and segregation, and lower rates of TAVI persisted (interaction p-value 0.003). Segregation and race were not independently associated with 30-day mortality. Conclusions: Living in a high-segregation county is independently associated with decreased population-level rates of AS diagnosis and receipt of TAVI for Black, but not white, individuals. Among Black people living in high-segregation counties, disparities in TAVI rates are associated with decreased AS diagnosis and access to TAVI.
Abstract 11264: The Impact of the COVID-19 Pandemic on Cardiac Implantable Device Monitoring in Urban and Suburban Settings
Authors: Rahul Patel, Tanya Khasnavis, Sallie Gustafson, Michael S Lloyd
Journal: Circulation (2022)

Introduction: Remote and in-person monitoring of cardiac implantable devices is an important component to the overall healthcare of cardiology patients. The impact of the pandemic on follow-up and missed appointment rates at cardiology device clinics after the onset of shutdowns is unclear. We analyzed the impact of the COVID-19 pandemic on in-person and remote appointment no-show rates across a large network of cardiology device clinics, including three urban hub clinics and thirteen suburban and rural spoke sites. Methods: 60,750 encounters at Emory Healthcare’s Cardiology Device Clinic between 1/1/2019-12/31/2019 (“pre-COVID”) and 8/1/2020-7/31/2021 (“post-COVID”) were included. Visits were stratified by “in-person” and “remote” appointment types and analyzed according to no-show or completed status. Subgroup analysis was performed of geographic location (urban vs suburban) clinic sites. A chi-square test was used to analyze statistical significance (p &lt; 0.05). Results: The cohort consisted of 26,356 “pre-COVID” and 34,394 “post-COVID” scheduled device visits. The overall no-show rates were higher in the post-COVID time frame (16.5% in 2019 and 19% in 2021-2021, p &lt; 0.001). The higher no-show rates were similar for in-person and remote visits (19.5% vs 21.3% p &lt;0.01 in-person; 15.6% vs 18.5% p &lt;0.001 remote). There were differences in types of no-show rates among urban versus sub-urban clinic sites. For urban sites, there was no impact on in-person no-show rates (20.8% vs 20.3%, p = 0.64) for in-person appointments, but a significant difference (13.6% vs 17.3%, p &lt; 0.01) for remote appointments. In contrast, for suburban sites, pre and post-COVID missed appointment rates showed effects on in-person visits (15.7% vs 23.4%, p &lt; 0.01), but not for remote appointments (48.2% vs 46.9%, p = .56). Conclusions: The COVID-19 pandemic impacted long-term in-person and remote device monitoring rates significantly. The effects were different depending on urban versus suburban site location. This analysis of over 60,000 device monitoring visits revealed a substantial impact on no-show rates for all visits and site-specific trends for the type of no-show affected, which may help in the design of higher-adherence follow up schedules in the post-COVID era.
Abstract 11340: Characteristics of Patients Admitted to a Contemporary Cardiac Intensive Care Unit With Valvular Cardiogenic Shock
Authors: Raunak M Nair, Sanchit Chawla, Feras Alkhalaileh, Bahaa Abdelghaffar, Umesh N Khot, Andrew Higgins, Ran Lee, Wael A Jaber, Paul C Cremer, Penelope Rampersad, Venu Menon
Journal: Circulation (2022)

Background: Cardiogenic shock (CS) is a heterogeneous clinical entity associated with poor outcomes. Patients with CS primarily due to an acute valvular dysfunction (valvular cardiogenic shock; VCS) constitute a unique cohort who remain poorly defined. We sought to define the prevalence and underlying patient characteristics of patients with VCS. Methods: All patients admitted to Cleveland Clinic Cardiac Intensive Care Unit (CICU) between Jan 1 st , 2010, to Dec 31 st , 2021, with a diagnosis of CS were retrospectively identified through electronic medical records and confirmed via physician directed chart review. Patients with CS were subsequently categorized into those with VCS and non-VCS depending on the primary etiology responsible for CS. Characteristics of patients with VCS were analyzed to descriptively define this entity. Patients with mixed shock and those with incomplete variables were excluded. Results: Overall, 2754 patients were admitted to our CICU with CS of which 511 (18.6%) were determined to have VCS. The median age of patients with VCS was higher than those with non-VCS (70 yrs vs 64yrs, P&lt;0.001). Patients with VCS were also more likely to be females (40.5% vs 31.8%, P&lt;0.001), have higher prevalence of atrial fibrillation (56.9% vs 48.5%, p=0.001), chronic obstructive pulmonary disease (26.4% vs 20%, p=0.002), and prior history of valve replacement or repair (29.7% vs 7.9%, p&lt;0.001) (Table 1). Patients with VCS were also significantly less likely to have prior MI (19.4% vs 46.6%, p&lt;0.001). The aortic valve was most commonly implicated; with more native valve dysfunction as compared to prosthetic valve dysfunction (73% vs 27%, p&lt;0.001). (Figure 1). Conclusion: One in 5 patients admitted with CS has VCS with native valves and the aortic position being the common culprit. The availability and impact of emergent percutaneous structural-interventions on clinical outcomes in this population warrants investigation.
Abstract 11278: Association of Homocysteine and C-Reactive Protein With Post-Stroke Depression: A Meta Analysis and Meta Regression
Authors: Vikash Jaiswal, Song Peng Ang, Tejasvi Kainth, Angela Ishak, Amey Joshi, Kriti Kalra, DATTATREYA MUKHERJEE, Jia Ee Chia, Akash Jaiswal
Journal: Circulation (2022)

Introduction: Post-stroke depression (PSD) is a common neuropsychiatric complication of stroke with a high incidence of 31% and that is associated with poor functional outcomes and increased mortality. Its pathophysiology is poorly understood, however, evidence suggests that neuroinflammation in reaction to the stroke could play a role in the development of PSD. Hypothesis: To compare C-reactive protein (CRP), and homocysteine (Hcy) levels in post-stroke patients with and without depression. Methods: We systematically searched all electronic databases from inception until May 30th 2022 comparing baseline CRP and Hcy. Results: A total of 12 studies with 3,154 Patients were included in this analysis. The mean age of the overall cohort was 64.8 years with PSD patients appearing to be older than non-PSD patients (mean 67.3 years vs 63.8 years). In terms of gender distribution, there were more females in the PSD group compared with non-PSD groups (48.9% vs 40.7%). PSD patients were more likely to be widowed (18% vs 7.25%) and had a family history of psychiatric disorder (10.4% vs 4.4%) compared to non-PSD patients. Patients with PSD had higher levels of baseline CRP [SMD 0.86, (95% CI 0.65 to 1.08), p&lt;0.001; I2=87%] and Hcy PSD [SMD 1.12, (95% CI 0.57 to 1.67), p&lt;0.001; I2=96%] compared to patients without PSD. Meta-regression was performed using covariates including age, female gender, hypertension, diabetes mellitus, CAD, NIHSS, widowhood and family history of psychiatric disorder. Diabetes mellitus appeared to be the only significant effect modifier (coefficient 0.23, p=0.01) for the association between baseline CRP and PSD. Conclusions: Elevated baseline levels of CRP and Hcy were significantly higher in patients that developed PSD, suggesting that both could play a role in the pathophysiology of PSD and as a potential biomarker for diagnosing risk of depression
Abstract 11732: Assessing Efficacy of Post-Acute Heart Failure Discharge Follow-Ups at a Safety-Net Hospital
Authors: Preetham Gunta, Aamer Ubaid, Kashvi Gupta, Angel Lopez-Candales
Journal: Circulation (2022)

Introduction: Recent data shows that when adults are discharged after hospitalization for acute heart failure (HF), a clinic follow up with either cardiology or general medicine within 7 days results in significantly lower chances of 30 day readmissions. We sought to analyze the trends of clinic follow up after acute HF hospitalization and the associated barriers and facilitators at our safety net hospital. Methods: Data was extracted from the electronic medical records using ICD 9,10 codes for acute HF admissions between Jan 2019 and Dec 2021. Quarterly trends of rates of clinic follow up were analyzed over the past 3 years; t-test was used to assess for statistical significance. Multivariable logistic regression models were constructed to test the association between patient level factors and clinic follow up after adjusting for sociodemographic factors. A p value &lt; 0.05 was used to establish significance. Results: Of 1,037 patients admitted for acute HF between 2019-2021, 29.5% were 65 years or older, 64.7% were males, 48.7% were Black and 16.6% were uninsured. Only 8% and 23.1% had a 7 and 14 day clinic follow up respectively. Of those with scheduled follow up 65% and 56% showed up to their appointments at 7 and 14 days respectively. Overtime we noted an increase in the proportion of encounters with a 7 day follow up although the effective follow up (after accounting for no-shows) remained unchanged. Patients that had an inpatient cardiology consult had higher odds of getting a 7 day follow up (OR=1.42, p value = 0.001) after adjusting for age, gender, insurance status and race (black &gt; white, OR = 1.34, p&lt;0.001). Conclusions: Our study showed that the effective 7 day follow up did not improve from 2019 to 2021 likely due to COVID19 pandemic. However, a significantly higher proportion of patients obtained 7 day appointments in the last quarter with room for improvement. Steps to increase follow up rates include intervening on the highlighted modifiable factors to achieve better results.
Abstract 11441: Triplane Left Atrial Strain
Authors: Jorge Eduardo Hernandez del Rio, Tomas Miranda - Aquino, MICHEL MACHUCA HERNANDEZ, MARIA CEPEDA ROCHA, SERGIO HERRERA MENDEZ, Ramon Esturau, Christian Gonzalez Padilla
Journal: Circulation (2022)

The objective was to compare the percentage of myocardial deformation of the left atrium evaluated by monoplanar, biplanar and triplanar measurement. A total of 126 healthy patients were collected, of which 71 (56%) were male, the mean age of the population was 38 years (±16). Intraobserver and interobserver variability were adequate.The different values of the left atrium were compared. For the reservoir strain, only a significant difference was found between the apical 3-chamber and apical 2-chamber values reported; in pump strain there were no significant differences in values obtained; for the conduit strain, again the apical 3-chamber view was the lowest, finding a significant difference with the apical 4c, apical 2c and biplane views.The concordance of the reservoir strain of each apical view was independently related to the biplane and triplane views, finding that both apical 2c and 4c views had a good concordance with both biplane and triplane views, however, apical 3c view had a lower concordance. The same was found for pump strain and conduit strain, being Apical 2c and 4c views superior. Conclusion: The 3-chamber view has different left atrial strain values than the other apical views and the concordance of all other values of left atrium examination are similar, hence it is not further significant to perform a biplane or triplane examination.
Abstract 11186: Clinical Presentation and Outcome of Myocarditis After Covid-19 Vaccination Among Adolescents: A Systematic Review and Meta-Analysis
Authors: Kaihei Masuda, Jun Yasuhara, Tadao Aikawa, Hisato Takagi, Toshiki Kuno
Journal: Circulation (2022)

Introduction: The association of the COVID-19 vaccination with myocarditis has been reported in adolescents. However, evidence of myocarditis after COVID-19 vaccination among adolescents is scarce compared to adults. We aimed to investigate the clinical features and outcomes of COVID-19 mRNA vaccination-related myocarditis in adolescents. Methods: PubMed and EMBASE were searched through April 2022 to investigate the characteristics of vaccine-associated myocarditis in adolescent patients (aged 12-20 years) through observational studies, case series, and correspondence according to PRISMA guidelines. Data regarding patient characteristics, the type, and dose of the vaccine, laboratory data, imaging studies, mortality, and treatments were extracted from each article. One-group meta-analysis in a random-effects model was performed. Results: 22 observational studies were identified, including 861 cases of vaccine-associated myocarditis. The mean age was 16.0 (95%CI, 15.5-16.5), and the male was predominant at 90.8%. Three-quarters of myocarditis occurred after the second dose (78.2%, 95% CI, 62.4- 94.0). The incident rate was higher after the second dose (12.7 -118.7 per million persons) than the first dose (0.6-10.0 per million persons). Chest pain (85.2%) was the common presenting symptom. Although 16.0% of patients (51/302) had left ventricular (LV) systolic dysfunction (LV ejection fraction [EF] &lt; 55%), most of the cases (40/289) were mildly reduced LVEF as 45-54% (12.0% of total patients). Interestingly, cardiac magnetic resonance imaging revealed late gadolinium enhancement in 80.5% (95% CI, 65.7-95.2) of the cases. Overall, 92.8% of patients required hospitalization, and 14.7% required intensive care unit admission. However, no in-hospital mortality was observed (0/230), and the length of stay at the hospital was less than 5 days. Conclusions: This systematic review and meta-analysis demonstrate a low incident rate and largely favorable outcomes of COVID-19 vaccine-associated myocarditis in adolescents. Our findings would help better understand myocarditis following COVID-19 mRNA vaccination among adolescents and decision-making for parents with vaccine hesitancy.
Abstract 111: Ischemic Post Conditioning After Asphyxial Arrest In A Diabetic Rat Model
Authors: Matthew Barajas, Takuro Oyama, Masakazu Shiota, Zhu Li, Lauren Zaylskie, Miriam Walter, Matthias L Riess
Journal: Circulation (2022)

Diabetes (DM) is a pervasive disease associated with increased risk of cardiac arrest (CA) and worse survival. Diabetics display abrogation of post arrest therapies. Ischemic post-conditioning (IPoC) has been shown to improve outcomes in young healthy swine, but never in a DM model. We hypothesized that IPoC would be beneficial for survival of non-DM rats after asphyxial CA and that this benefit would be abrogated in DM. Male Wistar rats were utilized, 12 of 23 underwent induction of DM with injection of streptozotocin (30mg/kg) IP and feeding of western diet for 12 weeks. Rats were intubated, mechanically ventilated, and anesthetized with isoflurane. A non-invasive flow probe was placed on a carotid artery. An internal jugular vein and femoral artery and vein were cannulated. Electrocardiogram, echocardiogram, and arterial blood gas were analyzed. Asphyxial CA, induced by rocuronium and cessation of ventilation, proceeded for 7 min. CPR was initiated utilizing an automated chest compressor at a rate of 200/min. Animals were randomly assigned to standard CPR (S-CPR) or IPoC. IPoC was initiated 40 seconds into CPR with a 20 sec pause followed by 20 sec of compressions, 1 cycle. This cycling was performed 4 total times after which S-CPR was continued. Defibrillation and epinephrine were given, as necessary. Data were collected every 40 sec during CPR and at 15 min, 1 and 2 hr after return of spontaneous circulation (ROSC). Data were analyzed using ANOVA with pairwise comparisons. Significance set at p &lt;.05. Non-DM rats displayed high rates of ROSC in both S-CPR, and IPoC groups, 100% (5 of 5) and 83% (5 of 6) respectively. DM S-CPR rats had a reduced ROSC rate at 14% (1 of 7) which improved to 80% (4 of 5) with IPoC. There were no significant differences between DM S-CPR and IPoC groups during CPR. Only DM rats required defibrillations. DM rats had a significantly longer time to ROSC, higher epinephrine requirement, lower nadir pH, and lower carotid blood flow at end experiment. There was no difference in any marker between non-DM S-CPR and IPoC groups after ROSC. DM was associated with increased injury from CA. IPoC was not harmful to non-DMs but improved ROSC rate and thus survival in DM rats. This is a novel demonstration of IPoC utility in a historically conditioning resistant group.